A NEW COMPETITIVE ADVANTAGE

The future has arrived for pharmacies and PBMs. And it’s no longer “business as usual.”

With competition arriving not just from the traditional healthcare sector but the online giants, Cognizant helps retail, specialty and mail order pharmacies and PBMs rethink operating models—and deliver more targeted and personalized services in a differentiated way.

DRIVING BETTER HEALTH OUTCOMES

The ability to access and leverage data is changing the way business decisions are made, with rich insights enabling evidence-based decision-making and proactive planning. Cognizant provides expertise on the data that should be collected across a wide range of attributes affecting pharmacy and PBM businesses, helping you make well informed decisions in:

FROM DETECTION TO PREVENTION

Enabling organizations to identify and resolve intentional and unintentional errors or verify the absence of both is critical. With significant capital being lost to fraud and abuse each year, investigation and recovery efforts are key to an organization’s overall financial health.

EMPOWER CONSUMERS WITH DIGITAL TOOLS

New consumer-focused operating models in healthcare demand a shift in thinking, requiring many companies to go from a B2B to B2C focus. Cognizant helps healthcare organizations manage the patient and member experience with solutions that drive engagement and help build effective strategies for member identification and retention. Our services span these areas:

HEALTHCARE

Higher Healthcare Plan Volumes, Lower Performance Guarantee Payouts

The Challenge

Each year, U.S. health insurance companies provision millions of dollars in anticipation of health plan inaccuracies and legal penalties. To deliver accurate health benefits and minimize legal payouts, insurers must ensure their systems are ready for business at the start of the new year.

A leading U.S.-based retail pharmacy and pharmacy benefits manager faced high payouts every year due to erroneous claims. The company wanted to raise the bar on the customer experience with improved patient-centric care and more accurate claims administration.

Our Approach

Cognizant modernized the company’s benefit plan rollouts using BenefitSERV, our Intelligent Product for platform-based benefits configuration and automated validation. We improved the customer experience with a three-pronged strategy: pharma experts who focus on the end user; accurate coding of benefits plans; and end-to-end automation of the validation process.

More Flexible, Accurate and Competitive Health Plans

With Cognizant’s end-to-end approach to quality assurance (QA) the company achieves both a many-fold increase in plan volumes and 100 percent compliance with its “plan active by date” targets. Our solution improves plan accuracy to 99.5 percent, helping the company reap significant savings in payouts—and increase its bottom line. Better plan accuracy also translates to member satisfaction.